高齡>38歲以上者隨內膜增厚並未改善懷孕率

 

高齡>38歲以上者隨內膜增厚並未改善懷孕率

 

 

我在西北大學試管嬰兒訓練以第二作者發表權威的生殖期刊Fertility & Sterility

 

Title

Increased endometrial thickness is associated with
improved treatment outcome for selected patients
undergoing in vitro fertilization–embryo transfer

 

增加子宮內膜厚度在特定的case可改善試管嬰兒患者的治療結果

 

(Fertil Steril 2005;83:336–40. ©2005 by American Society for Reproductive Medicine.)
Xingqi Zhang, Ph.D.,a Chi-Huang Chen (陳啟煌), M.D.,b Edmond Confino, M.D.,a Randall Barnes, M.D.,aMagdy Milad, M.D.,a and Ralph R. Kazer, M.D.a

a Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Feinberg School of
Medicine of Northwestern University, Chicago, Illinois; and b Department of Obstetrics and Gynecology, Tri-Service General
Hospital, National Defense Medical Center, Taipei, Taiwan

(Fertil Steril 2005;83:336–40. ©2005 by American Society for Reproductive Medicine.)

 

PS:高齡>38歲以上者隨內膜增厚並未改善懷孕率

 

 

 

 塑化劑風暴何時平息？如滾雪球不見停損

·         2011-06-01

·         中廣新聞／林麗玉

 

塑化劑風暴從5月下旬持續延燒，遭波及的食品有如滾雪球越滾越大，從最早的運動飲料、一路波及水果口味加工品、水果飲料、茶飲、果漿、果凍、果醬等，連還有民眾常吃的保健食品膠囊錠粉狀食品，也都有許多知名廠商遭波及。而衛生署訂定5月31號為終止黑心起雲劑的D-day，從31號凌晨零點開始，五大類食品，包括「運動飲料」、「果汁飲料」、「茶飲料」、「果醬、果漿或果凍」、「膠囊錠狀粉狀」等食品，如果沒有食品安全證明，一律不得在架上販售，而D-day大限到期的首波稽查，許多超商、超市、賣店，根本還搞不清楚如何陳列食品安全證明，許多超商、超市等，就將許多商品品項的食品安全證明放置成一大疊，遭衛生單位開立限改單，光是以台北市為例，首波稽查，就稽查數千件商品，因為無法提出安全證明，立即被要求下架，要等補齊資料之後，才能再上架販售。

 

 

 

生育與絕育。 2011年5月28日搶鮮版。

 

 

 

(本土的研究上了國際生殖頂尖期刊)

 

標題

 

暴露在聚氯乙烯丸(PVC)工廠空氣中的工人其塑化物二（2乙基己基）鄰苯二甲酸酯（DEHP塑化物）濃度與精液質量的關係

 

 

 

高雄國立高雄第一科技大學，嘉義崇仁護理學院

摘要

目的：探討暴露在聚氯乙烯丸(PVC)工廠空氣中的工人其塑化物二（2乙基己基）鄰苯 二甲 酸酯（DEHP塑化物）濃度與精液質量的關係

設計：橫斷面研究。 

地點：台灣聚氯乙烯工廠。 

患者：受聘於兩個聚氯乙烯粒料廠的四十五位男性工人。 

研究係數（補）：無。主要結果測量（補）：精子濃度，活動力，形態和染色質 DNA完整性進行訪問。 

結果：工人分為低和高DEHP的暴露組按照DEHP的平均水平（23.7微克/立方米（3））的個人空氣。在高DEHP的暴露組，顯著上升趨勢中找到精子DNA變性（αT）誘導，DNA片段化指數（DFI），能夠飲用咖啡傾向。調整後喝咖啡，吸煙，年齡，個人空氣中DEHP的濃度呈正協會與αT（β= 0.038）和DFI（β= 0.140），並與精子活力呈負相關（β= -0.227）。 

結論：這是首次研究證明 周圍的空氣中DEHP的濃度和不利影響精子活力和染色質 DNA完整性之間有關聯。鑑於目前廣泛使用這些 PVC製品，其意義為鄰苯 二甲 酸鹽的毒性和職業健康也有相當大的影響。 

 

原文

 

 

權威期刊: 人類生殖。 2011年6月4日。 搶鮮版

口服避孕藥和子宮內膜異位症：過去使用口服避孕藥治療重度原發性痛經與子宮內膜異位症，特別是深層浸潤子宮內膜異位症的關聯。

 

法國巴黎的研究

摘要

使用口服避孕藥（OC）和子宮內膜異位症之間的關係仍存在爭議。因此，我們比較其各種特性，使用口服避孕藥，手術病理診斷子宮內膜異位症分為表淺的子宮內膜異位症(SUP)，卵巢子宮內膜異位瘤（OMA）的或深層浸潤子宮內膜異位症（DIE）。方法為橫斷面研究包括566例手術時無子宮內膜異位症者為對照，410例病理證實子宮內膜異位症，其分類為SUP47例，OMA120例及DIE243例。個人數據，包括使用口服避孕藥，在標準化下，前瞻性地收集採訪。統計分析採用非條件 logistic回歸。結果過去口服避孕藥使用者治療原發性痛經有子宮內膜異位症發病率上升（調整奇比（OR）= 2.79，95％可信區間（CI）1.74-5.12，P值0.002）的機會。結論我們的數據表明，使用口服避孕藥去治療嚴重原發性痛經的病史，在以後的生活發現嚴重原發性痛經是與手術診斷子宮內膜異位症，尤其是深層浸潤子宮內膜異位症（DIE）很有關聯，。然而，這並不一定意味著使用口服避孕藥增加了子宮內膜異位症的發生的風險。以往使用口服避孕藥治療原發性痛經的病史可作為婦女子宮內膜異位症併有深層浸潤子宮內膜異位症（DIE）的一個標記。

 

PS: 截至目前為止，教課書及國際上仍建議口服避孕藥用來治療或控制子宮內膜異位症，本篇僅用於提供法國研究的觀察。

 

 

Hum Reprod. 2011 Jun 4. [Epub ahead of print]

Oral contraceptives and endometriosis: the past use of oral contraceptives for treating severe primary dysmenorrhea is associated with endometriosis, especially deep infiltrating endometriosis.

Chapron C, Souza C, Borghese B, Lafay-Pillet MC, Santulli P, Bijaoui G, Goffinet F, de Ziegler D.

Source

Service de Gynécologie Obstétrique II and Reproductive Medicine (Professor Chapron), Université Paris Descartes, Faculté de Médecine, Assistance Publique-Hôpitaux de Paris (AP- HP), Groupe Hospitalier Universitaire (GHU) Ouest, Centre Hospitalier Universitaire (CHU) Cochin Saint Vincent de Paul, Paris , France .

Abstract

BACKGROUND The relationship between the use of oral contraception (OC) and endometriosis remains controversial. We therefore compared various characteristics of OC use and the surgical diagnosis of endometriosis histologically graded as superficial peritoneal endometriosis (SUP), ovarian endometrioma (OMA) or deep infiltrating endometriosis (DIE). METHODS This cross-sectional study included 566 patients without visible endometriosis at surgery as controls, and 410 patients with histologically proven endometriosis, categorized by their worst lesions as SUP n = 47, OMA n = 120 and DIE n = 243. Personal data, including on OC use, were prospectively collected during standardized interviews. Statistical analysis was performed using unconditional logistic regression. RESULTS Past OC users had an increased incidence of endometriosis (adjusted odd ratios (OR) = 2.79, 95% confidence interval (CI) 1.74-5.12, P = 0.002) of any revised American Fertility Society stage. Women who had previously used OC for severe primary dysmenorrhea were even more frequently diagnosed with endometriosis (adjusted OR = 5.6, 95% CI 3.2-9.8), especially for DIE (adjusted OR = 16.2, 95% CI 7.8-35.3). Women who had previously used OC for other reasons also had an increased risk of endometriosis, but to a lesser extent (adjusted OR = 2.6, 95% CI 1.8-4.1). The age at which OC was initiated, duration of OC use and free interval from last OC use were not significantly different between control and endometriosis women, irrespective of histological grading. Current OC users did not show an increased prevalence of endometriosis (OR = 1.22, 95% CI 0.6-2.52). CONCLUSIONS Our data indicate that a history of OC use for severe primary dysmenorrhea is associated with surgical diagnosis of endometriosis, especially DIE, later in life. However, this does not necessarily mean that use of OC increases the risk of developing endometriosis. Past use of OC for primary dysmenorrhea may serve as a marker for women with endometriosis and DIE.

 

 

人類生殖。 2011年6月9日。搶鮮版

 

來自德國的研究

 

最終人工生殖(試管嬰兒)的成功率：10年的調查

 

摘要

 

背景

 

累積懷孕率(CPR)和活產率（CLBRs）在IVF成功的評估比每個單一週期的相關係數或胚胎移植而言是較好的指標。它們讓病人有一個更好的估計有孩子的機會並且可比較各生殖中心的治療策略。

 

方法

為 10年第一次接受輔助生殖技術週期進行的世代研究。病患術後接受追蹤，直到活產或停止治療。所有IVF和ICSI新鮮週期和來自2PN的冷凍胚胎包括在內。累積懷孕率(CPR)和活產率（CLBRs）的估計採用 Kaplan- Meier法 ，包含治療週期數和植入胚胎數。分析認為夫妻不回後續處理週期與那些誰繼續治療者將有同樣的成功機會。結果1998年至和2007年共3011治療的婦女包括在內，2068位兒童出生，婦女曾生過孩子者重新進入分析作為一個‘新的病人。對於3394病人共8048週期進行觀察，3個週期（週期的中位數每名患者）活產率CLBR為 52％，6個週期為72％， 12個週期為85％。年齡達到40歲以下的患者，累計轉移後的六個胚胎活產率CLBR〜50％。從一個新鮮的週期和其隨後的冷凍週期的平均活產率為33％。我們的分析顯示，人工生殖(試管嬰兒)能達到自然生育率，但無法超過自然生育率。

 

結論

 

大多數夫婦不孕的問題如果他們繼續治療能夠得到成功治療，從而可以達到自然的生育率。即使國情的限制如德國胚胎保護法，活產率CLBR仍可達到相當的國際標準。

 

 

PS: 鼓勵各位繼續為人工生殖(試管嬰兒)奮鬥的

 

朋友，永不放棄，終嘗甜蜜的果實，擁抱孩子。

 

 

 

Hum Reprod. 2011 Jun 9. [Epub ahead of print]

 

Final ART success rates: a 10 years survey.

Gnoth C, Maxrath B, Skonieczny T, Friol K, Godehardt E, Tigges J.

Source

Centre for Family Planning, Gynaecological Endocrinology and Reproductive Medicine (green-ivf), Department of Obstetrics and Gynaecology (Director: Prof. Peter Mallmann), University of Cologne , Rheydter Str. 143, D-41515 Grevenbroich, Germany.

Abstract

BACKGROUND Cumulative pregnancy rates (CPRs) and live birth rates (CLBRs) are much better indicators of success in IVF programmes than cross-sectional figures per cycle or embryo transfer. They allow a better estimation of patient’s chances of having a child and enable comparisons between centres and treatment strategies. METHODS A 10 year cohort study of patients undergoing their first assisted reproductive technique cycle was conducted. Patients were followed until live birth or discontinuation of treatment. All IVF and ICSI cycles and cryo-cycles with embryos derived from frozen pronuclear stage oocytes were included. The CPR and CLBR were estimated using the Kaplan-Meier method for both the number of treatment cycles and transferred embryos. The analysis assumed that couples who did not return for subsequent treatment cycles would have had the same chance of success as those who had continued treatment. RESULTS A total of 3011 women treated between 1998 and 2007 were included, and 2068 children were born; women already with a live birth re-entered the analysis as a ‘new patient’. For 3394 ‘patients under observation’ with 8048 cycles, the CLBR was 52% after 3 cycles (the median number of cycles per patient), 72% after 6 cycles and 85% after 12 cycles. A CLBR of ∼50% was achieved for patients aged under 40 years, after the cumulative transfer of six embryos. The mean live birth rate from one fresh cycle and its subsequent cryo-cycle(s) was 33%. Our analysis also shows that ART can reach natural fertility rates but not exceed them. CONCLUSIONS Most couples with infertility problems can be treated successfully if they continue treatment. Thereby ART can reach natural fertility rates. Even with the restrictions in place as a result of the German Embryo Protection Law, CLBR reach internationally comparable levels.

 

 

  何謂原發性卵巢功能不全（POI）？

原發性卵巢功能不全（primary ovarian insufficiency-

POI）是一個狀況，其中一個女人在她所剩無幾的卵供應或

完全排光卵的年齡為 40以前。因為大約 1％的女性會過渡

到絕經年齡小於 40歲，並不包括婦女停經在40歲或超出

40。POI與缺乏月經週期一直比較通常稱為卵巢早衰

(primary ovarian failure-POF）。然而，許多專家現在認

為，POI是一個比較準確的術語，因為在許多情況下，卵巢

還沒有完全“失敗”，而是可能仍然起作用，產生激素或釋

放卵子。如果低卵供應與不孕，還有些人指POI作為減少卵

巢庫存（Diminished Ovarian Rreserve）。然而，重要的

是要指出的是卵供應量低過早發生可能有超出生育能力重大

影響身體健康。 

 

 

權威的不孕期刊

人類生殖。 2011年6月13日。 [搶鮮版] 

特發性原發性卵巢功能不全：一項系列性

荷爾蒙量變曲線評估卵巢濾泡活動的研

究。 

來自印度的研究

摘要 

背景

卵巢卵泡荷爾蒙系列性量變曲線有報導高達86％的原發性卵巢功能不全（POI）患者具有卵巢卵泡活動性。在大多數這些研究中，患者有過短暫時間的閉經或不規則的月經週期可能影響卵泡的發生自發性的活動。其目的是研究婦女自發 POI和閉經1年時間系列性荷爾蒙量變曲線發生卵泡活動的發生率。參與這項研究的方法觀察 20例自發 POI，閉經為> 1年期和正常染色體。測量血清卵泡刺激素（FSH），促黃體激素（LH），雌二醇（E2），黃體酮(P4)，游離 T3& T4，促甲狀腺激素 (TSH) 和抗甲狀腺抗體，在沒有採取補充雌激素，追蹤每週測量血清E2，FSH，LH和孕酮1個月，然後每月測量連續 2個月。提高血清E2> 184 pmol / L (50.12 pg/mL)和血清孕酮> 10 nmol / L(3.14ng/mL)的測量活動作為證據卵泡和排卵，分別。結果:2/18位有顯著的上升的血清E2> 184 pmol / L (50.12 pg/mL) [11.1％，95％可信區間（CI）：1.4-34.7％。雖然相應的血清FSH值呈下降，值仍> 40 IU / L。沒有對受試者血清孕酮水平(P4)> 10 nmol / Ｌ(3.14ng/mL)的，返回月經或懷孕。結論內源性卵巢濾泡功能間歇目前只有11.1％的 POI的亞洲的印度婦女出現。然而，由於樣本量小，95％CI（1.4-34.7％）是顯著的。

 

PS:臨床上常看到自己ＦＳＨ很高的朋友，覺得自己快停經了，然而此文針對嚴重的卵巢早衰患者探討，因是亞洲人的體質，雖研究sample size太小，仍須注意恢復卵巢活性仍有可能的。所以ＡＭＨ低且ＦＳＨ高的朋友要掌握好週期接受人工生殖。

 

Hum Reprod. 2011 Jun 13. [Epub ahead of print]

Idiopathic primary ovarian insufficiency: a study of serial hormonal profiles to assess ovarian follicular activity.

Goswami D, Arif A, Saxena A, Batra S.

Source

Department of Obstetrics and Gynecology, Maulana Azad Medical College and Lok Nayak Hospital , New Delhi 110002, India .

Abstract

BACKGROUND Ovarian follicular activity in serial hormone profiles has been reported in up to 86% of patients with primary ovarian insufficiency (POI). In most of these studies, patients had a short duration of amenorrhea or irregular menstrual cycles which could influence the occurrence of spontaneous follicular activity. The aim was to study the incidence of follicular activity in serial hormonal profiles of women with spontaneous POI and amenorrhea of 1 year duration. METHODS This observational study involved 20 patients with spontaneous POI, amenorrhea of >1 year duration and normal karyotype. Serum measurements of follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), progesterone, free T3, free T4, thyroid-stimulating hormone and anti-thyroperoxidase antibodies, taken in the absence of estrogen replacement, were followed by weekly measurements of serum E2, FSH, LH and progesterone for 1 month then monthly measurements for 2 months. Increases in serum E2 >184 pmol/l (50.12 pg/mL) and serum progesterone >10 nmol / L (3.14ng/mL)  were taken as evidence of follicular activity and ovulation, respectively. RESULTS A rise in serum E2 >184 pmol/l was noted in 2/18 subjects [11.1%; 95% confidence interval (CI): 1.4-34.7%]. Though the corresponding serum FSH levels showed a decline, the values remained >40 IU/l. None of the subjects had serum progesterone levels >10 nmol/l, return of menses or pregnancy. CONCLUSION Endogenous ovarian follicular function is intermittently present in only 11.1% of Asian Indian women with POI. However, the 95% CI (1.4-34.7%) was large due to a small sample size.

 

 

Hum Reprod. 2011 Jun;26(6):1551-4. Epub 2011 Apr 5. (搶鮮版)

 

 

來自日本的研究

 

 

 

後代的性別比例是與母親月經初潮的年齡有關 

摘要

 

提前月經初潮(初經)的年齡是乳癌和卵巢癌的危險因素，也與增加自然流產率。

 

目的

 

是探討是否有早期月經初潮年齡之間和後代的性別比例的關聯。

 

方法

 

我們記錄了10 847停經前婦女(平均出席年齡：37.5 ± 7.2歲，範圍 22-54歲）共生出21208活產出生嬰兒的性別，參加了我們的產科和婦科診所的評估。我們計算的新生兒性別比例相對於母親的月經初潮年齡（從 9到18歲），向每名婦女生育的嬰兒數（即生育指數）。

 

結果

 

觀察母親誰進入初潮年齡在9歲;的比值比（OR）（95％置信區間）相比，有低後代的性別比例（男/女）的0.800(女多男少)，那些與對照組 14歲初潮為 0.72（0.29-1.79）。在性別比例仍然很低，直到該組的母親誰進入初潮在12歲 [1.009，OR：0.90（0.85-0.95）]。性別比最高(逐漸男多女少)，觀察母親與月經初潮年齡 14歲（1.118，OR：1.00控制），它逐漸下降，直至月經初潮年齡 17歲 [1.000; OR：0.89（0.15-5.26）](男女平衡)。婦女月經初潮年齡在9歲至11歲，生育率指數(胎數)也很低，。

 

結論

女性進入月經初潮超出正常範圍，特別是那些月經初潮早，可能有增加的機會生女生。 

PS: 懷孕時baby的性別一直是所有懷孕夫妻最關切的，初經早多生女，這來自同是黃種人的日本的統計研究，很有趣。參考之!

 

Hum Reprod. 2011 Jun;26(6):1551-4. Epub 2011 Apr 5.

The sex ratio of offspring is associated with the mothers’ age at menarche.

Fukuda M, Fukuda K, Shimizu T, Nobunaga M, Grete Byskov A, Yding Andersen C.

Source

M&K Health Institute, 30-9 Kariya, Ako, Hyogo 678-0239, Japan .

Abstract

BACKGROUND Early menarcheal age is a risk factor for breast and ovarian cancers and is also associated with an increased spontaneous abortion rate. The aim of this study was to investigate whether there is a link between early menarcheal age and the offspring sex ratio. METHODS We recorded the sex of 21208 live born infants, all singletons, born to 10 847 premenopausal women (mean attending age: 37.5 ± 7.2 years, range 22-54) who attended our clinics for obstetrical and gynaecological assessment. We calculated the sex ratio of newborn infants in relation to the mothers’ age of menarche (from 9 to 18 years) and to the number of infants per woman (i.e. fertility index). RESULTS A low offspring sex ratio (males/females) of 0.800 was observed in mothers who entered menarche at the age of 9 years; the odds ratio (OR) (95% confidence intervals) compared with those of control group with menarche at age 14 was 0.72 (0.29-1.79). The sex ratio remained low, until the group of mothers who entered menarche at 12 years of age [1.009; OR: 0.90 (0.85-0.95)]. The highest sex ratio was observed in mothers with a menarcheal age of 14 years (1.118; OR: 1.00 control) and it gradually decreased until the menarcheal age of 17 years [1.000; OR: 0.89 (0.15-5.26)]. The fertility index was also low in women with menarche at the age of 9 to 11 years. CONCLUSIONS Women entering menarche outside the normal range, especially those with earlier menarche, may have an increased chance of producing female offspring.

 

           

 

 

生育與絕育2011 Aug 5. 搶鮮版

 

來自美國的研究

 

肥胖的效應對輔助人工生殖技術成果的影響

 

：一個全國性的研究。

摘要
目的：評價肥胖對女性的反應和結果的人工輔助生殖技術（ART）的治療的影響。

設計：歷史性的世代研究

設定：診所為基礎的數據。

病人（S）：共152,500 人工輔助生殖技術(ART)週期開始從社會的人工輔助生殖技術的臨床結果報告系統 2007-2008年，僅限於婦女記錄的高度和分組身體質量指數（BMI [體重 /身高²]）。

干預（S）：無。

主要觀察指標（S）：取消整週期，取消週期由於低反應，治療失敗（沒有懷孕與懷孕），和妊娠失敗（流產或死胎與活產），經調整的比值比和95％的信心間隔，週期之間的正常體重的婦女作為對照組。

結果：全週期取消全和取消由於預行取卵而對排卵藥低反應顯著與增加BMI相關。治療失敗的機率大幅上升與自體新鮮週期，從 1.03個週期中超重的婦女（BMI 25.0-29.9），以1.53的週期與女性的BMI≥50.0公斤/米²。同樣，懷孕失敗的機率是最重要的增加體重的婦女與自體新鮮週期，提高1.10個週期從超重婦女 2.29個週期，以婦女為 BMI≥50.0公斤/米²。

結論（S）：這些結果表明肥胖者週期取消機率明顯高於正常人。此外，治療和妊娠失敗的增加明顯增加肥胖與超重的婦女有關。

 

PS:人工生殖前該減肥了，把BMI控制在18-22最佳。

 

Fertil Steril. 2011 Aug 5. [Epub ahead of print]

The effect of increasing obesity on the response to and outcome of assisted reproductive technology: a national study.

Luke B, Brown MB, Missmer SA, Bukulmez O, Leach R, Stern JE; a Society for Assisted Reproductive Technology writing group.

Source

Department of Obstetrics, Gynecology, and Reproductive Biology, Michigan State University, East Lansing and Grand Rapids, Michigan; Department of Epidemiology, Michigan State University, East Lansing, Michigan.

Abstract

OBJECTIVE:

To evaluate the effect of increasing female obesity on response to and outcome of assisted reproductive technology (ART) treatment.

DESIGN:

Historical cohort study.

SETTING:

Clinic-based data.

PATIENT(S):

A total of 152,500 ART cycle starts from the Society for Assisted Reproductive Technology Clinical Outcomes Reporting System for 2007-2008, limited to women with documented height and grouped by body mass index (BMI, [weight/height(2)]).

INTERVENTION(S):

None.

MAIN OUTCOME MEASURE(S):

Cycle cancellation overall, cycle cancellation due to low response, treatment failure (not pregnant vs. pregnant), and pregnancy failure (fetal loss or stillbirth vs. live birth), as adjusted odds ratios and 95% confidence intervals, with cycles among normal-weight women as the reference group.

RESULT(S):

Cycle cancellation overall and cancellation due to low response using autologous oocytes significantly paralleled increasing BMI. The odds of treatment failure rose significantly with autologous-fresh cycles, from 1.03 for cycles among overweight women (BMI 25.0-29.9) to 1.53 for cycles among women with BMIs ≥50.0 kg/m(2). Likewise, the odds of pregnancy failure were most significant with increasing BMI among women with autologous-fresh cycles, increasing from 1.10 for cycles to overweight women to 2.29 for cycles to women with BMI ≥50.0 kg/m(2).

CONCLUSION(S):

These results indicate significantly higher odds of cycle cancellation. In addition, treatment and pregnancy failures with increasing obesity significantly increased starting with overweight women.

 

 

 

出處:第一名的不孕症期刊

 

Hum Reprod Update. 2011年7月6日 搶鮮版

促性腺激素釋放激素激動劑觸發(GnRHa)用於試管嬰兒療程黃體支持以提高活產率的系統評價和綜整分析

 

來自希臘的研究 

摘要 
本系統評價和綜整分析，以評估是否對促性腺激素釋放激素激動劑觸發(GnRHa)用於黃體支持ICSI / IVF週期提高活產的概率。方法文獻檢索系統（MEDLINE，EMBASE，中央和登記 RCT）進行，以確定相關的隨機對照試驗的全部手稿出版。 Meta分析得出的數據匯集風險差異（RDS）和95％可信區間（CI）。隨機效應模型應用於池的研究。結果確定了六個相關隨機對照試驗共包括2012的患者。概率的活產率（RD：16％，95％CI：+10至+22％）顯著的病人接受促性腺激素釋放激素激動劑觸發(GnRHa)的高於那些沒有使用者。該小組分析根據類型的GnRH類似物用於 LH抑制並沒有改變效果觀察（促性腺激素釋放激素激動劑觸發(GnRHa)的研究中，期間使用了卵巢刺激，RD：15％，95％CI：+5至+23％）;研究中GnRH拮抗劑期間使用了卵巢刺激，RD：+19％，95％CI：+11至+27％）。結論現有的最佳證據表明，促性腺激素釋放激素激動劑觸發(GnRHa)在黃體期顯著增加的活產率。 

 

PS: 促性腺激素釋放激素激動劑觸發(GnRHa)的角色多彩多姿。豐富了人工生殖的應用。目前促性腺激素釋放激素激動劑觸發(GnRHa)用於調控刺激排卵前或中對腦下垂體及卵巢的性腺荷爾蒙的影響。也用於取代破卵針於PCOS或預防OHSS的功能。本篇令人有興趣的是系統性評價和綜整分析促性腺激素釋放激素激動劑觸發(GnRHa)用於取卵或排卵以後的黃體期,是因GnRHa激動劑的機制對胚胎和子宮內膜也有直接影響且有益影響黃體期而增加活產率。

 

 

 

 

Hum Reprod Update. 2011 Jul 6. [Epub ahead of print]

Increased live birth rates with GnRH agonist addition for luteal support in ICSI/IVF cycles: a systematic review and meta-analysis.

Kyrou D, Kolibianakis EM, Fatemi HM, Tarlatzi TB, Devroey P, Tarlatzis BC.

Source

Unit for Human Reproduction, Department of Obstetrics and Gynaecology, Medical School, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Nea Efkarpia Peripheral Road, Thessaloniki 54603, Greece.

Abstract

BACKGROUND The aim of this systematic review and meta-analysis was to evaluate whether the addition of GnRH agonist for luteal support in ICSI/IVF cycles enhances the probability of live birth. METHODS Systematic literature search (MEDLINE, EMBASE, CENTRAL and RCT registries) was conducted to identify relevant randomized controlled trials published as full manuscripts. Meta-analysis of data yielded pooled risk differences (RDs) and 95% confidence intervals (CIs). A random effects model was applied for pooling the studies. RESULTS Six relevant RCTs were identified including a total of 2012 patients. The probability of live birth rate (RD: +16%, 95% CI: +10 to +22%) was significantly higher in patients who received GnRH agonist support compared with those who did not. The subgroup analysis according to the type of GnRH analogue used for LH suppression did not change the effect observed (studies in which GnRH agonist was used during ovarian stimulation, RD: +15%, 95% CI: +5 to +23%); (studies in which GnRH antagonist was used during ovarian stimulation, RD: +19%, 95% CI: +11 to +27%). CONCLUSIONS The best available evidence suggests that GnRH agonist addition during the luteal phase significantly increases the probability of live birth rates.

 

 

 

 

Hum Reprod. 2011年8月24日 (搶鮮版)

出處:第二名的不孕症期刊

 

雙邊卵巢子宮內膜異位瘤手術對停經年齡的影響

 

來自意大利的研究

摘要

 

背景

手術切除的卵巢子宮內膜異位可能導致卵巢功能受損仍然是Questions。為了檢驗這一假設，卵巢子宮內膜異位傷害的卵巢功能的手術加速卵巢衰竭而研究本文。

 

方法

在三級大學醫院，縱向前瞻性世代研究。患者之間接受1993年3月和2007年11月被評定為子宮內膜異位症腹腔鏡手術在研究納入一項前瞻性追蹤 3，6和12個月，然後每年進行。月經模式，症狀和生育的結果研究。

結果

在超過 14年的時間追蹤，302例患者納入研究。患者平均年齡（± SD）為 32.6 ± 5.6歲;在後續時間中位數為 8.5年（範圍 2-17年）。更年期是記錄在43名婦女（14.3％）在平均年齡為 45.3 ± 4.3歲（範圍 32-52歲）。以前接受雙邊切除術的婦女在絕經年齡比單側卵巢子宮內膜異位手術者早停經（42.1 ± 5.1與47.1年± 3.5歲，P = 0.003）。卵巢早衰（POF）觀察 7/ 43（16.3％）在絕經期的患者; 雙邊子宮內膜異位瘤切除後，大部分（4，57.1％）。雙邊子宮內膜異位瘤切除和術前卵巢子宮內膜異位瘤大小和絕經年齡有顯著關係（R（2）= 0.754，P = 0.002）。

結論

患者動了雙邊子宮內膜異位瘤切除手術有增加卵巢早衰竭的風險。卵巢在手術時實質的損失似乎與囊腫的大小有關。在單側卵巢子宮內膜異位的情況下，完整的對側卵巢可能適當補償卵巢功能。

 

PS: 過大的卵巢子宮內膜異位瘤，手術仍是必要的，然而要慎選時機及手術醫師，2次卵巢子宮內膜異位瘤手術對復發者特別是不孕或未婚者傾向別再度切除，卵巢體積會大幅遞減，卵子少甚至連人工生殖時卵庫存量也很少，進而早發停經。

 

 

Hum Reprod. 2011 Aug 24. [Epub ahead of print]

 

Ovarian surgery for bilateral endometriomas influences age at menopause.

Coccia ME, Rizzello F, Mariani G, Bulletti C, Palagiano A, Scarselli G.

SourceDepartment of Science for the Health of Woman and Child, University of Florence , Via Ippolito Nievo 2, 50129 Florence , Italy .

 

Abstract

BACKGROUNDQuestions remain as to whether surgical excision of ovarian endometriomas might cause damage to ovarian function. To test the hypothesis that ovarian surgery for endometrioma compromises ovarian function and accelerates ovarian failure.METHODSIn a tertiary university Clinic, longitudinal prospective cohort study. Patients who underwent laparoscopy for endometriosis between March 1993 and November 2007 were assessed for inclusion in the study. A prospective follow-up at 3, 6 and 12 months then yearly was conducted. Evolution of menstrual pattern, symptoms and reproductive outcomes were investigated.RESULTSFrom over the 14-year period, 302 patients were included in the study. The mean age (±SD) of patients was 32.6 ± 5.6 years; the median duration of follow-up was 8.5 years (range 2-17 years). Menopause was documented in 43 women (14.3%) at a mean age of 45.3 ± 4.3 years (range 32-52 years). Women previously submitted to bilateral cystectomy were younger at menopause than those with monolateral endometrioma (42.1 ± 5.1 years versus 47.1 ± 3.5 years, P = 0.003). Premature ovarian failure (POF) was observed in 7 of 43 (16.3%) menopausal patients; the majority (4, 57.1%) after bilateral cystectomy. The relationship between the preoperative ovarian endometriomas total diameter and menopausal age was significant in case of surgery for bilateral endometriomas (R(2) = 0.754, P = 0.002).CONCLUSIONSPatients who had been operated on for bilateral endometriomas have an increased risk of POF. Ovarian parenchyma loss at the time of surgery seems related to cyst diameter. In the case of unilateral ovarian endometrioma, the contralateral intact ovary might adequately compensate.

 

Hum Reprod. 2011年9月19日 (搶鮮版)

出處:第二名的不孕症期刊

 

檢查基礎血液FSH反應卵巢庫存與試管嬰兒妊娠的產科負面結局的風險之間的關係

 

來自美國北卡羅萊納大學教堂山分校的研究

 

摘要

背景

 

試管嬰兒治療不育症可能與早產（PTB）及低出生體重（LBW）的發病率較高的風險。我們的目的是檢查是否檢查卵巢基礎血液FSH反應卵巢庫存與PTB和LBW之間從 IVF治療.的關係。

 

方法

 

導致懷孕的風險，輔助生殖技術數據庫，包括所有的婦女經歷了一個新鮮的非捐卵的IVF治療 ，一個在2008年美國國IVF週期產生一個單胞胎回顧性世代研究，每個病人有一個記錄的基礎血清FSH值（N = 14 262）的記錄。使用的FSH值是最大的基底或克羅米芬刺激的血清水平。登錄二項式模型的建立是為了評估協會之間的FSH和PTB（<37週），與 FSH和低出生體重（<2500克），產婦年齡調整後，種族，孕/校驗，早產過，吸煙，BMI和嬰兒gender.

 

結果

 

Data 14 086例患者進行了分析。 FSH水平和低出生體重的危險呈負相關。 FSH水平最高四分位數（≥9 MIU / ml）的婦女最高的調整，平均孕週（271.2天），最低調低出生體重 [0.87，95％的信心區間（CI）的相對危險度（RR）：0.76 1.01，最高的調整後的平均出生體重（3249克）和最低調整 RR低出生體重（0.89，95％CI：0.73-1.04）。

 

結論

 

最大的基礎 FSH水平和單胎試管嬰兒妊娠早產（PTB）及低出生體重（LBW）的危險呈反比關係。表明，卵巢儲備減少是不是試管嬰兒妊娠早產（PTB）及低出生體重（LBW）的肇因。

 

陳醫師的Comment:

卵巢庫存與試管嬰兒妊娠的產科負面結局的風險之間的關係似乎不大，年輕者(<38歲)即使AMH低，FSH高表現卵巢庫存低應不致於影響產科負面結局。高齡者(>40歲)則回歸自然法則。

 

 

Hum Reprod. 2011 Sep 19. [Epub ahead of print]

Examining the relationship between ovarian reserve, as measured by basal FSH levels, and the risk of poor obstetric outcome in singleton IVF gestations.

Calhoun KC, Fritz MA, Steiner AZ.

Source

Department of Obstetrics and Gynecology, Division of REI, University of North Carolina at Chapel Hill, 4001 Old Clinic Building, CB 7570, Chapel Hill, NC 27599-7570, USA.

Abstract

BACKGROUNDThe higher prevalence of preterm birth (PTB) and low birthweight (LBW) following infertility treatment may relate to the treatment itself or indicate that subfertility predisposes to a higher risk. Our aim was to examine whether basal FSH levels are related to the risk for PTB and LBW among pregnancies resulting from IVF.METHODSWe studied a retrospective cohort in the 2008 National Society for Assisted Reproductive Technology Database, including all women who underwent a fresh non-donor IVF cycle resulting in a singleton live birth having a recorded basal serum FSH value (n = 14 262). The FSH value used was either the maximum basal or clomiphene-stimulated serum level. Log binomial models were created to assess the associations between FSH and PTB (<37 weeks), and between FSH and LBW (<2500 g), adjusting for maternal age, ethnicity, gravidity/parity, history of PTB, smoking, BMI and infant gender.RESULTSData for 14 086 patients were analyzed. FSH levels were inversely related to the risk of PTB and LBW. Women in the highest quartile of FSH levels (≥9 mIU/ml) had the longest adjusted mean gestational age (271.2 days), the lowest adjusted relative risk (RR) of PTB [0.87, 95% confidence interval (CI): 0.76-1.01], the highest adjusted mean birthweight (3249 g) and the lowest adjusted RR of LBW (0.89, 95% CI: 0.73-1.04).CONCLUSIONSThe inverse relationship between maximal basal FSH levels and the risk for PTB and LBW in singleton IVF gestations suggests that diminished ovarian reserve is not the primary mediator of the increased prevalence of PTB and LBW in IVF pregnancies.